摘要
目的探讨退行性脊柱畸形(degenerative spinal deformity,DSD)的胸腰椎三维活动度特征。方法于2018年5月至2021年5月在陆军军医大学第一附属医院骨科招募的100例被试者,畸形组60例(均以腰弯方向区分向左侧凸39例,向右侧凸21例)和同期健康体检组40例作为对照组。采用手持关节角度仪测量被试者的胸椎左右侧屈、左右旋转、腰椎前屈后伸、左右侧屈活动度。于站立位拍摄脊柱全长正侧位X线片,测量冠状面Cobb角,确定顶椎位置并做好记录。在胸腰椎脊柱MRI的顶椎横断面T_(2)W1像上测量顶椎旋转度(apical vertebra rotation,AVR)。比较两组被试者在胸腰椎活动度的差异,并在畸形组中分析胸腰椎活动度和AVR以及Cobb角的相关性。结果DSD组腰椎冠状面(侧屈)和矢状面(屈伸)的整体活动度、其胸椎在水平面(旋转)的活动度显著小于对照组(P<0.01)。左侧弯畸形组的腰椎前屈和后伸、右侧屈(凹侧)及胸椎左旋转(凹侧)右旋转(凸侧)均显著低于对照组(P<0.05)。右侧弯畸形组中,腰椎后伸、左侧屈(凹侧)、右侧屈(凸侧)以及胸椎左旋转(凹侧)、右旋转(凸侧)显著低于对照组(P<0.05)。在畸形组中,腰椎凸侧侧屈活动度与Cobb角(r=-0.282,P=0.035)和AVR(r=-0.343,P=0.010)均呈显著负相关。结论DSD在各方向上均存在一定的脊柱活动度受限,在腰椎上主要以前屈后伸和侧屈受限为主,在胸椎上以旋转受限为主;腰椎凸侧侧屈活动度和AVR与Cobb角密切相关。
Objective To explore the characteristics of thoracic and lumbar mobility in patients with degenerative spine deformity(DSD).Methods A total of 60 patients with degenerative spine deformity(DSD)admitted in our hospital from May 2018 to May 2021 were recruited in the study,and another 40 healthy individuals who taking physical examination during same period served as control group.The patients including 39 cases of scoliosis convex to the left and 21 cases to the right.A handheld joint actiometer was used to measure thoracic vertebrae left-right lateral flexion,left-right rotation,and lumbar vertebrae flexion and extension,left and right lateral flexion in the deformed group and control group.The parameters,including coronal Cobh angle(CA)and apical vertebra(AV)were measured on the X-ray films of the whole spine in the standing position.The apical vertebra rotation(AVR)was measured on the cross-sectional T_(2)W1 image of MRI.Differences in thoracic and lumbar vertebrae range of motion(ROM)were compared between the 2 groups,and the correlation of thoracic and lumbar vertebrae ROM with AVR and CA angle were analyzed in the deformed group.Results The overall ROM of the lumbar lateral flexion,flexion,extension and the ROM of the thoracic vertebra rotation were significantly smaller than those of the control group(P<0.01).In the left-sided curved deformities,the lumbar flexion,extension,lateral flexion(concave)and thoracic rotation(concave,convex)were significantly smaller than those in the control group(P<0.05).In the right-sided curved deformities,the lumbar extension,lumbar flexion(concave,convex),and thoracic rotation(concave,convex)were significantly small than in the control group(P<0.05).In the deformed group,the lumbar lateral flexion(convex)was significantly negatively correlated with both CA angle(r=-0.282,P=0.035)and AVR(r=-0.343,P=0.010).Conclusion DSD patients have limitations in spinal mobility in all directions.The mobility limitation for lumbar spine mainly focuses on flexion and extension(sagittal plane)and lateral flexion(coronal plane),while mobility limitation for thoracic vertebrae mainly concentrates on rotation.The lateral flexion mobility on the convex side are closely associated with the Cobb angle and AVR.
作者
李凯
杨森
武文杰
杨乾坤
魏小雨
陈灿
喻学科
陈春华
罗飞
LI Kai;YANG Sen;WU Wenjie;YANG Qiankun;WEI Xiaoyu;CHEN Can;YU Xueke;CHEN Chunhua;LUO Fei(Department of Orthopedics,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Department of Orthopedics,Hospital of Eight-Third Army Group,Xinxiang,Henan Province,453000,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第6期556-562,共7页
Journal of Army Medical University
基金
军队后勤科研重大项目(AWS17J004)
关键词
退行性脊柱畸形
胸椎
腰椎
活动度
degenerative spinal deformity
thoracic vertebrae
lumbar vertebrae
range of motion
作者简介
通信作者:罗飞,E-mail:luofeispine@126.com
